Patent Application
20240032902
The present inventive concepts relate to the field of tissue sampling in living beings, and is particularly useful for tissue sampling in living mammals.
In various medical diagnostic, treatment, and research contexts it is particularly useful to be able to sample tissue for testing and analysis. As examples, clinical uses in the field of cardiology of tissue sampling include, but are not limited to, testing tissue of transplant recipients to assess for possible rejection, and diagnosing various maladies, e.g., cardiac sarcoid, amyloidosis, subtypes of myocarditis, intracardiac tumors. As further examples, research uses of tissue sampling include, but are not limited to, transcriptomics—multiple and single cell and Das 2019—Cardiac biopsies in CABG patients→Transcriptomics of HFpEF.
In 1972, Caves modified the Konno biopsy for use through the right internal jugular vein. This modification allowed the bioptome to be inserted percutaneously, but the large diameter of the bioptome head required use of a large (non-valved) sheath that placed the patient at risk for bleeding or air embolization at the time of bioptome insertion or removal. The technique did allow several advantages, including percutaneous insertion, use of local anesthetic allowing minimal discomfort to the patient, rapid performance, direct passage of the bioptome to the right ventricular apex, and repeated entry and exit through the same sheath.
Caves subsequently introduced the Stanford modification to the previous Konno bioptome. The Stanford (or Caves-Shulz) bioptome included two hemispheric cutting jaws with a combined diameter of 3 mm (9F) mounted on the catheter tip. One of the jaws remained stationary while the other opened and closed under the control of a mosquito-like clamp at the proximal end of the catheter used to extract tissue. Spring-loaded adjustable nuts allowed the operator to adjust the amount of force applied with opening and closing of the surgical-like clamp. Because this bioptome was reusable, it required careful cleaning after each use and ultimately needed retooling and sharpening of the cutting edges of the jaws after 50 procedures.
However, significant limitations are associated with the foregoing apparatus and approach. For example, using a bioptome catheter had a 0.54% risk of major complications, e.g., perforation. This risk increased when not sampling interventricular septum. Additionally, the jaws have a tendency to crush the sampled tissue, which can be negatively impactful in transbronchial lung cryobiopsy which has been used to sample lung tissue in the diagnosis of lung disease. The technique is performed by passing a probe through the working channel of a bronchoscope out to the lung periphery. The probe tip is rapidly cooled until cryoadhesion occurs between the tip and adjacent lung tissue. A tissue sample is extracted by firmly pulling on the probe tip. The probe is then removed with bronchoscope from the airway.
Cryobiopsy has not been used to sample heart tissue. Sampling heart tissue within a cardiac chamber, which cannot be simply performed through an airway, poses challenges not encountered with lung cryobiopsy. Being able to remove only tissue cells from the cardiac wall would be particularly beneficial, doing minimal damage, rather than adhering and removing chunks of tissue pulled from a lung wall.
According to an aspect of the inventive concepts, a cardiac cryobiopsy method comprises a plurality of steps, including introducing a cryoprobe (or cryogenic probe) into a cardiac chamber of a body, e.g., through blood vessels leading to the heart; steering a probe tip to a tissue harvesting site within a cardiac chamber; bringing the probe tip to a harvesting temperature below freezing and maintaining contact until cardiac tissue or cells from the site adheres to the probe tip through freezing; and, while maintaining the probe tip at or below freezing while retracting the probe tip from the body to transport the harvested tissue from the cardiac chamber to outside the body.
In some embodiments, the method further comprises, once the probe tip is outside the body, raising the temperature of the probe tip to above freezing to release the harvested cardiac tissue or cells.
In some embodiments, the method further comprises, once the probe tip is removed from the body, removing the probe tip, or a portion thereon, with cardiac tissue or cells adhered thereto from the probe.
In some embodiments, the cryoprobe includes an elongate catheter having a proximal end and a distal. The distal end comprises the probe tip, and the proximal end comprises a refrigerant inlet port and a refrigerant outlet port. The method further includes introducing refrigerant to the probe tip via the inlet port and through the catheter, thereby lowering the temperature of the probe tip; and evacuating the refrigerant via the outlet port and through the catheter shaft.
In some embodiments, the probe tip includes a micro-tube and the method further includes: injecting the refrigerant as liquid refrigerant into the probe tip; evaporating the refrigerant in the probe tip to lower the probe tip temperature; and evacuating the refrigerant as refrigerant gas from the probe tip.
In some embodiments, the method further comprises controlling the temperature of the probe tip via a controller comprising a processor.
In some embodiments, the probe tip includes at least one sensor coupled to the processor and the method further comprises sensing a temperature of the probe tip and/or refrigerant entering and/or exiting the probe tip and regulating the probe tip temperature based on a sensed temperature.
In some embodiments, the method further comprises sensing the presence and/or absence of the cardiac tissue or cells adhered to the probe tip.
In some embodiments, the method further comprises establishing a feedback loop between the at least one sensor and controller to enable the controller to monitor and regulate the probe tip temperature.
In accordance with another aspect of the inventive concept, provided is a cardiac cryobiopsy method. The method comprises introducing a cryoprobe into a cardiac chamber of a body; steering a probe tip to a tissue harvesting site; bringing the probe tip to a harvesting temperature below freezing and contacting cardiac tissue at the tissue harvesting site until cardiac tissue or cells adhere to the probe tip through freezing; and while maintaining the probe tip at or below freezing, retracting the probe tip from the body.
In some embodiments, the method further comprises, once the probe tip is removed from the body, raising the temperature of the probe tip to above freezing to release the harvested cardiac tissue or cells from the probe tip.
In some embodiments, the method further comprises, once the probe tip is removed from the body, removing the probe tip, or a portion thereon, with the harvested cardiac tissue or cells adhered thereto from the probe.
In some embodiments, the cryoprobe includes an elongate catheter having a proximal end and a distal, wherein the distal end comprises the probe tip, and the proximal end comprises a refrigerant inlet port and a refrigerant outlet port. And the method includes introducing refrigerant to the probe tip via the inlet port and through the catheter, thereby lowering the temperature of the probe tip and evacuating the refrigerant via the outlet port and through the catheter shaft.
In some embodiments, the probe tip includes a micro-tube and the method includes injecting the refrigerant as liquid refrigerant into the probe tip; evaporating the refrigerant in the probe tip to lower the probe tip temperature; and evacuating the refrigerant as refrigerant gas from the probe tip.
In some embodiments, the method further comprises controlling the temperature of the probe tip via a controller comprising a processor that controls a flow of the refrigerant within the probe.
In some embodiments, the probe tip includes at least one sensor coupled to the processor and the method includes sensing at least one condition at the probe tip.
In some embodiments, the at least one condition at the probe tip is a temperature and/or presence of a tissue sample.
In some embodiments, the method further comprises, using the at least one sensor, sensing a temperature of the probe tip and/or refrigerant entering and/or exiting the probe tip.
In some embodiments, the method further comprises, using the at least one sensor, sensing the presence and/or absence of the cardiac tissue or cells adhered to the probe tip.
In some embodiments, the method further comprises, using the at least one sensor, sensing the presence and/or absence of the cardiac tissue or cells adhered to the probe tip using an optical sensor.
In some embodiments, the method further comprises establishing a feedback loop between the at least one sensor and the controller to enable the controller to monitor and regulate the probe tip temperature.
In some embodiments, the method further comprises maintaining the probe tip temperature at or below freezing after exiting the body for at least 10 seconds, at least 30 seconds, or at least 1 minute.
In some embodiments, the method further comprises maintaining the probe tip temperature at or below freezing after exiting the body until a user input received via a user interface directs the controller to enable to probe tip temperature to rise above freezing.
In some embodiments, the method further comprises sensing an ambient temperature outside the body and setting the probe tip temperature within the cardiac chamber based on the sensed ambient temperature outside the body.
In some embodiments, the method further comprises setting the probe tip temperature below freezing based on the sensed ambient temperature and a duration of time the probe tip is to be at or below freezing outside the body.
In accordance with another aspect of the inventive concept, provided is a cardiac cryobiopsy apparatus or system. The apparatus comprises: a cryoprobe having a cryogenic probe tip and configured for introduction into a cardiac chamber via a blood vessel; a steering mechanism configured to steer the probe tip to a tissue harvesting site within the cardiac chamber; and a controller comprising a processor. The controller is configured to bring the probe tip to a temperature at or below freezing to adhere cardiac tissue and/or cells to the probe tip and maintain the probe tip a temperature at or below freezing through retraction of the probe tip from the body to harvest the adhered cardiac tissue and/or cells.
In some embodiments, the controller is further configured to raise the temperature of the probe tip to above freezing to release the harvested cardiac tissue or cells from the probe tip once the probe tip is removed from the body.
In some embodiments, the probe tip, or a portion thereon, is removable with the harvested cardiac tissue or cells from the probe once the probe tip is removed from the body.
In some embodiments, the cryoprobe further includes a proximal end comprising an inlet port and an outlet port and at least one microtube configured to inject a liquid refrigerant received via the inlet port into the probe tip, wherein the probe tip defines a chamber configured to receive the liquid refrigerant and transition the liquid refrigerant from a liquid state to a gas state to lower the probe tip temperature, and wherein the probe defines a gas evacuation path from the probe tip to the outlet port.
In some embodiments, the controller is further configured to control the temperature of the probe tip.
In some embodiments, the probe tip includes at least one sensor coupled to the processor and configured to sense at least one condition at the probe tip.
In some embodiments, the at least one condition at the probe tip is a temperature and/or presence of a tissue sample.
In some embodiments, the controller and the at least one sensor are configured to sense a temperature of the probe tip and/or refrigerant entering and/or exiting the probe tip.
In some embodiments, the controller and the at least one sensor are configured to sense the presence and/or absence of the cardiac tissue or cells adhered to the probe tip.
In some embodiments, the controller and the at least one sensor are configured to sense the presence and/or absence of the cardiac tissue or cells adhered to the probe tip using an optical sensor.
In some embodiments, the apparatus further comprises a feedback loop between the at least one sensor and the controller to enable the controller to monitor and regulate the probe tip temperature.
In some embodiments, the controller is configured to maintain the probe tip temperature at or below freezing after exiting the body for at least 10 seconds, at least 30 seconds, or at least 1 minute.
In some embodiments, the controller is configured to maintain the probe tip temperature at or below freezing after exiting the body until a user input received via a user interface directs the controller to enable to probe tip temperature to rise above freezing.
In some embodiments, the controller comprises an ambient temperature sensor and the controller is further configured to set the probe tip temperature within the cardiac chamber based on a sensed ambient temperature outside the body.
In some embodiments, the controller is further configured to set the probe tip temperature below freezing based on the sensed ambient temperature and a duration of time the probe tip is to be at or below freezing outside the body.
The present inventive concepts will become more apparent in view of the attached drawings and accompanying detailed description. The embodiments depicted therein are provided by way of example, not by way of limitation, wherein like reference numerals refer to the same or similar elements. The drawings are not necessarily to scale, emphasis instead being placed upon illustrating aspects of the inventive concepts.
In the drawings:
Various aspects of the inventive concepts will be described more fully hereinafter with reference to the accompanying drawings, in which some exemplary embodiments are shown. The present inventive concept may, however, be embodied in many different forms and should not be construed as limited to the exemplary embodiments set forth herein.
It will be understood that, although the terms first, second, etc. are be used herein to describe various elements, these elements should not be limited by these terms. These terms are used to distinguish one element from another, but not to imply a required sequence of elements. For example, a first element can be termed a second element, and, similarly, a second element can be termed a first element, without departing from the scope of the present invention. As used herein, the term “and/or” includes any and all combinations of one or more of the associated listed items.
It will be understood that when an element is referred to as being “on” or “connected” or “coupled” to another element, it can be directly on or connected or coupled to the other element or intervening elements can be present. In contrast, when an element is referred to as being “directly on” or “directly connected” or “directly coupled” to another element, there are no intervening elements present. Other words used to describe the relationship between elements should be interpreted in a like fashion (e.g., “between” versus “directly between,” “adjacent” versus “directly adjacent,” etc.).
The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used herein, the singular forms “a,” “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises,” “comprising,” “includes” and/or “including,” when used herein, specify the presence of stated features, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups thereof.
Spatially relative terms, such as “beneath,” “below,” “lower,” “above,” “upper” and the like may be used to describe an element and/or feature's relationship to another element(s) and/or feature(s) as, for example, illustrated in the figures. It will be understood that the spatially relative terms are intended to encompass different orientations of the device in use and/or operation in addition to the orientation depicted in the figures. For example, if the device in the figures is turned over, elements described as “below” and/or “beneath” other elements or features would then be oriented “above” the other elements or features. The device may be otherwise oriented (e.g., rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly.
Exemplary embodiments are described herein with reference to cross-sectional illustrations that are schematic illustrations of idealized exemplary embodiments (and intermediate structures). As such, variations from the shapes of the illustrations as a result, for example, of manufacturing techniques and/or tolerances, are to be expected. Thus, exemplary embodiments should not be construed as limited to the particular shapes illustrated herein, but are to include deviations in shapes that result, for example, from manufacturing or reasonably foreseeable alternatives.
To the extent that functional features, operations, and/or steps are described herein, or otherwise understood to be included within various embodiments of the inventive concept, such functional features, operations, and/or steps can be embodied in functional blocks, units, modules, operations and/or methods. And to the extent that such functional blocks, units, modules, operations and/or methods include computer program code, such computer program code can be stored in a computer readable medium, e.g., such as non-transitory memory and media, that is executable by at least one computer processor.
In accordance with the inventive concepts, provided is a tissue sampling apparatus and method. In various embodiments, the tissue sampling apparatus and method is a cryobiopsy tissue sampling apparatus and method. In various embodiments, the cryobiopsy apparatus can be used to sample cardiac tissue, as a cardiac cryobiopsy (or cryogenic biopsy) apparatus. In various embodiments, the cryobiopsy apparatus can be used to sample tissue from other organs or parts of the body, e.g., from the stomach, kidney, liver, spleen, intestines, brain, and/or reproductive system.
The cardiac cryobiopsy apparatus can be used to remove a cluster of tissue cells, which can be a few tissue cells, rather than a relatively crude chunk of cardiac tissue, thereby causing minimal damage and disruption to the cardiac tissue at the harvesting site. Therefore, the sampled tissue (or harvested tissue) can include a small number of tissue cells from the harvest site.
In various embodiments, a cryobiopsy apparatus can include an intravenous probe having at least one probe tip capable of reaching temperatures sufficient to freeze tissue such that the tissue or cells adhere to the tip. The tip preferably remains at the freezing temperature through retraction of the probe so that the adhered tissue sample can be maintained on the probe tip through the complete retraction or removal process, from harvest site to at least the point of exiting the body or beyond, so that the harvested sample can be collected for its intended purpose. In some embodiments, the temperature of the probe tip is selectively maintained at below freezing even after the point of exiting the body, e.g., until a clinician raises the probe tip temperature above freezing to release the tissue sample from the probe tip.
In some embodiments, the probe tip temperature can be brought sufficiently low so that the temperature of the probe tip does not immediately rise above freezing in ambient room temperature. For example, in some embodiments, the probe tip temperature upon exit from the body can be sufficiently below freezing that the probe tip does not rise above the freezing temperature after exit for a freeze time (t). In some embodiments, t is at least one (1) minute, t is at least thirty (30) seconds, and/or t is at least ten (10) seconds. In some embodiments, a controller coupled to the probe can sense the ambient temperature, using an ambient temperature sensor 20, external to the body and adjust the probe tip temperature to achieve a desired freeze time t once the probe tip is removed from the body.
Cryoablation probes have been used to ablate tissue within a heart to remediate an arrhythmia by killing heart tissue through freezing (cell death). Some factors affecting cell death include: freezing temperature, freezing rate, freezing duration, thaw rate, and repeat freezing. The mechanism of cell death includes direct cellular damage, vascular failure, and/or immunological effect.
In such cryoablation systems, a probe tip is brought into contact with the endocardium and brought to a controlled freezing temperature intended to freeze a portion of the inner wall of the heart to a prescribed depth needed to kill the desired tissue to remedy the arrhythmia. Once the treatment is complete, and cell death has occurred, the probe tip is returned to a temperature above freezing and the probe is removed through the catheter sheath used for insertion. Cardiac wall tissue is not collected from the probe tip.
Unlike cryoablation, a cryobiopsy is fundamentally intended to avoid cell death and it is not a treatment therapy. Cryobiopsy, in accordance with the present inventive concepts, seeks to remove a sample of living tissue cells for subsequent analysis and testing. Because of the diametrically opposed goals of cryoablation and cryobiopsy, even if somewhat similar devices can be used in each, the method of using them would be dramatically different. In addition, setup and configuration of the cryo device could be different when used for different purposes. For example, the cryo device (or system) may have a controller implementing a different set of logic and computer program instructions to achieve a cryobiopsy rather than a cryoablation. In some embodiments, there may be different physical attributes and characteristics of a cryobiopsy device (or system) when compared to a cryoablation system, such as different size probe tips and/or different materials used in the probe tips.
In some embodiments, however, the same cryo device could be used for a cryoablation procedure and, then, a cryobiopsy procedure, if implementing appropriate logic for cryobiopsy. For example, the cryo probe can be advanced into the heart and used to perform a cryoablation and, then, the probe can be transitioned for use in performing a cryobiopsy at the ablation site or another site within the heart, but the cryoablation and the cryobiopsy remain to different procedures.
In various embodiments, a cryobiopsy is performed by the moist cardiac tissue at the harvest site freezing to the probe tip. In various embodiments, there may be a formation of ice at the tissue contact side which adheres the catheter probe tip to the tissue. The catheter, with the sampled tissue, is retracted whilst the tissue sample is still attached to the probe tip, which remains at or below freezing temperature through the retraction.
Examples of cryoprobes that can be used for a cryobiopsy include, but are not limited to various Flexible Cryoprobes 1 offered by Erbe, such as the 1.1 mm, 1.7 mm, 1.9 mm, 2.4 mm diameter, as illustrated in
In some embodiments, the cryoprobe 10 comprises a Flexible 9 French probe 12. A handle 14 includes lever controls 16 that enable steering of the probe 10 inside the body. The lever controls 16 also enable a user to control and manipulate tip curvature, as seen by arrows 23. The probe 10 includes the liquid refrigerant input port 18 and the refrigerant output port 19. The probe 10 can include an electrical connector 22 for driving ring electrodes 25 at a distal probe end. The electrical connector 22 could be coupled to a properly configured controller 24 that includes cryobiopsy logic for controlling a magnitude and a duration of freezing temperatures at the probe tip 26, and for tissue harvesting through extraction external to the probe sheath. The apparatus can include a user interface (UI) 21 that enables a user to interact with the apparatus and the probe 10 via the controller 24.
The temperature of the probe tip 26 can be controlled according to a harvesting temperature profile that dictates a temperature magnitude and duration needed to harvest the tissue (or cells) at the site. A profile can have a constant probe tip temperature during harvesting or the temperature can be varied or have different levels during different parts of the process. In some embodiments, the temperature can be controlled by an operator or by a preprogrammed controller. Temperature, surface area, probe tip pressure against the cardiac wall and duration can be parameters used in defining a harvesting profile, and can be monitored and/or controlled at the probe tip. Unlike cryoablation, however, the objective is to harvest live cells, not compromise or damage the tissue at the location to effect ablation.
The probe tip 26 is maintained at the freezing, harvesting temperature during harvesting, but also is maintained at a freezing, retraction temperature after harvesting is complete at the harvesting site, so that the cryoprobe can be retracted via the sheath without releasing the harvested tissue sample due to thawing (S34). The harvesting temperature and the retraction temperature can be the same or different, but are preferably below freezing in various embodiments.
In some embodiments, the probe tip 26 can include at least one sensor 30, e.g., an optical sensor, that indicates if tissue cells were harvested, as shown in
There can be various approaches to removing the tissue sample frozen to the probe tip 26, once retracted from the body. In various embodiments, once the probe 10 is out of the sheath and body, the probe tip 26 temperature can be transitioned above freezing to release the harvested tissue sample from the probe. In various embodiments, the release of the harvested tissue sample from the probe can include removing the tissue sample or cells from the tissue sample from the probe tip 26. In other embodiments, the release the harvested tissue sample from the probe can include removing the probe tip 26, or a portion thereof, with the tissue sample still attached from the probe 10, such that the tissue sample 32 with probe tip 26, or portion thereof, could be sent with the sample still frozen for analysis, rather than thawing beforehand.
In various embodiments, a cardiac cryobiopsy method comprises introducing a cryoprobe into a cardiac chamber of a body (S30); steering a probe tip 26 to a tissue harvesting site (S31); bringing the probe tip 26 to a harvesting temperature below freezing (S33) and maintaining contact until cardiac tissue or cells 32 adheres to the probe tip through freezing (S34); and while maintaining the probe tip at or below freezing, retracting the probe tip from the body (S35).
In some embodiments, the method can further comprise, once the probe tip is removed from the body, raising the temperature of the probe tip to above freezing to release the harvested cardiac tissue or cells.
In some embodiments, the method can further comprise, once the probe tip is removed from the body, removing the probe tip, or a portion thereon, with cardiac tissue or cells adhered thereto from the probe.
In some embodiments, the cryoprobe 10 includes an elongate catheter having a proximal end and a distal end. The distal end can comprise the probe tip 26 and the proximal end can comprise a refrigerant inlet port 18 and a refrigerant outlet port 19. The method can include introducing refrigerant to the probe tip 26 via the inlet port 18 and through the catheter, thereby lowering the temperature of the probe tip, and evacuating the refrigerant via the outlet port 19 and through the catheter shaft. The refrigerant may be output from the outlet port 19 as refrigerant gas.
In some embodiments, the probe tip 26 includes a micro-tube 28 and the method 300 includes injecting the refrigerant as liquid refrigerant into the probe tip 26 via the micro-tube 28, evaporating the refrigerant in the probe tip 26 to lower the probe tip temperature, and evacuating the refrigerant as refrigerant gas from the probe tip 26 and out outlet port 19.
In some embodiments, the method can further comprise controlling the temperature of the probe tip 26 via a controller 24 comprising a processor.
In some embodiments, the probe tip 26 includes at least one sensor coupled to the processor and the method further comprises sensing a temperature of the probe tip 26 and/or refrigerant entering and/or exiting the probe tip 26.
In some embodiments, method further comprises sensing the presence and/or absence of the cardiac tissue or cells adhered to the probe tip 26.
In some embodiments, the method further comprises establishing a feedback loop between the at least one sensor and the controller 24 to enable the controller 24 to monitor and regulate the probe tip 26 temperature.
While the foregoing has described what are considered to be the best mode and/or other preferred embodiments, it is understood that various modifications can be made therein and that the invention or inventions may be implemented in various forms and embodiments, and that they may be applied in numerous applications, only some of which have been described herein. It is intended by the following claims to claim that which is literally described and all equivalents thereto, including all modifications and variations that fall within the scope of each claim.
It is appreciated that certain features of the invention, which are, for clarity, described in the context of separate embodiments, may also be provide in combination in a single embodiment. Conversely, various features of the invention which are, for brevity, described in the context of a single embodiment may also be provided separately or in any suitable sub-combination.
For example, it will be appreciated that all of the features set out in any of the claims (whether independent or dependent) can combined in any given way.
This patent application claims the benefits of priority under 35 U.S.C. § 119 to U.S. Provisional Patent Application No. 63/122,712, filed Dec. 8, 2020, the entirety of which is incorporated herein by reference.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/IB2021/061459 | 12/8/2021 | WO |
| Number | Date | Country | |
|---|---|---|---|
| 63122712 | Dec 2020 | US |
